Patients in Simcoe County could be treated by enhanced paramedic care with what could basically be described as an emergency room on wheels.

But if and when the county becomes one of the last municipalities in southern Ontario to adopt advanced care paramedics (ACPs) is anyone's guess.

The county and the paramedics' union have been in negotiations since county councillors OK'd negotiations back in 2006, but whether the move is imminent is unclear.

"At this point in time, we really don't have a lot of information we can talk about," said Jane Sinclair, general manager of health and cultural services for Simcoe County. "It's fair to say it's a very complicated issue.

"The whole ACP discussions revolve around improving the level of paramedic services for the residents of Simcoe County and that's the nature of the discussions," she added.

Despite numerous attempts, union officials could not be reached for comment.

The county's ambulance service employs 270 primary care paramedics (PCP), including full-and part-time positions.

ACPs have a wider variety of pain-relief and sedation medication at their disposal, as well as several other procedures they can perform on the road.

Rob Theriault, co-ordinator of Georgian College's primary and advanced care paramedic programs, said it's time for Simcoe County to move towards an ACP program.

"It's a step in the right direction," he said. "There are quite a number of municipalities in

Ontario where paramedics services staff the ambulance with a split crew."

That setup tends to work well in other jurisdictions, Theriault added.

In a split-crew setup, the primary and advanced care paramedics tend to alternate calls, but the ACP will step up when their skills are required.

"The bulk of medical emergencies can be handled by primary care paramedics, (so) the county has been served very well," he said.

"But the advanced care para-m edic is a good addition because there are a small number of medical emergencies that can be handled at the advanced-care level."

One local paramedic who has been on the job for almost two decades, but didn't want his name published due to fear of repercussions from his employer, said an ACP program is needed in Simcoe County.

"We have major highways, ski hills, urban and rural communities, lakes and farms and wherever there is any sort of trauma or medical crisis, those who have the (ACP) training can basically bring the emerg to that call," he said, using broken bones as an example. "I have heard so many blood-curdling screams of pain when transporting patients with broken body parts."

On calls where a patient isn't likely to survive, an ACP could call into the hospital and speak to a physician, tell them what has been done and the doctor can pronounce death before the patient arrives at the hospital, the paramedic added.

"With that, we will not be drivi

ng with lights and sirens through the streets, having family members going to the hospital and finding out that the results are the same," the paramedic said. "That family can start grieving in the comforts of their own home instead of the hospital."

Theriault said he sees Simcoe County going ACP at some point.

"I think so, I certainly hope so," he said. "The base hospitals in Ontario are really behind it, in my estimation, so I suspect it will happen. I think the paramedics want it, that's my sense with speaking to paramedics here.

"It will be an expanded scope of practice for them, so they will be able to do more for the patients," Theriault added. "It's an increase in their education, which, in my mind, sort of improves the enjoyment of the career. More than anything, it just gives them the ability to do more."

Theriault has been in the business for 26 years and worked on the province's air ambulances for 10 years where he was a critical- care flight paramedic. He teaches full-time at Georgian, but also works part-time as an ACP in another municipality.

"There's still some municipalities that don't have advanced care paramedics yet," Theriault said. "Sometimes it's just a time issue, sometimes it's a matter of sorting out labour-management issues and agreeing on how that's going to roll out."

Since 2007, there has been funding in each year's Simcoe County budget to establish an ACP program which would result in the "gradual roll out" across the county of paramedics who have the enhanced skills.

"(ACPs) address a smaller number of potentially life-threatening emergencies or conditions that would require some symptom relief that are above and beyond what a primary care paramedic can do," Theriault said.

PCPs are able to address "the vast majority of garden-variety emergencies in the field and they're doing some really remarkable stuff now," he added. "They're diagnosing heart attacks and are able to transport patients directly to a balloon angioplasty centre, like Southlake (Regional Health Centre in Newmarket).

"But ACP, in my mind, is a great addition," Theriault said.

The county's four-year plan, whenever it gets launched, would initially include up to a dozen ACPs on the road while others are being trained, according to information in the 2007 budget. The end result is projected to be 52 ACPs on the road. But only one new position would be created if the county moves to an ACP program, with positions also being filled through growth and staff turnover.

However, Sinclair could not comment on whether those numbers are still accurate.

The service "enhancement" was budgeted at $331,000 in 2007, including $79,000 in salary for a ACP co-ordinator.

Those figures require approval from county council, Sinclair said. No one could provide a clear answer as to whether ACP is even a sure-thing.

"As far as timeframe, I don't think it will be (another) three years," said Mike Moffatt, direct

or of human resources for Simcoe County. "We're in the middle of a process," he said. "I have to respect the process and I think you have to respect the process, because what comes out of the process will determine the timeframe."

ACP candidates must go through a strict training regimen before they receive the designation, including interviews with hospital staff, such as physicians. They must pass a provincial test following classroom and on-the-road training.

"It is a huge commitment," the paramedic said. "A few medics have paid for it themselves in Simcoe County, but some are young and have the money to do it. Some have remortgaged their house to do it. Guys like me, with a young family and working two jobs, just can't do the training."

Despite more training and added responsibility, an ACP's pay is only nominally higher than a PCP in most municipalities.

According to the Ontario Paramedic Association, many PCPs are upgrading their qualifications as soon as they graduate, because there are more job prospects across Canada.

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